Secondary aorto-esophageal fistula after esophagectomy treated with endovascular treatment

RATIONALE Aorto-esophageal fistula (AEF), a postoperative complication of esophagectomy, constitutes a very small percentage of all cases presenting with AEF; however, it is associated with a high mortality rate. Acute massive hemorrhage is the single largest cause of death in patients developing AEF. There is a lack of consensus on the optimal treatment of AEF. PATIENT CONCERNS We present 3 cases secondary to esophagectomy due to lower thoracic esophageal carcinoma. All 3 patients presented with similar acute symptoms including a critical and life-threatening course with dead feeling, thoracic pain, and projectile hematemesis, and also hypovolemic shock. DIAGNOSES Digital subtraction angiography identified AEF as the diagnosis of these 3 cases. INTERVENTIONS All patients were treated with emergency thoracic endovascular aortic repair, the aortic fistulas were repaired. OUTCOMES All patients successfully survived the perioperative period. LESSONS Thoracic endovascular aortic repair, a minimally invasive technique, is a better method to achieve faster and safer hemodynamic stability in patients with AEF compared with open thoracic aortic repair.